1 C J Mieny, U Mennen: Principles of Surgical Patient Care - Volume ...

ClassificationForeign bodies can be classified on the basis of the following:- Composition- organic- inorganic- Physical properties. i.e. size and shape- Chemical properties, i.e. pH, solubility, stability, toxicity- Site in the bodyPathologyThe pathology caused by a foreign body will depend on its position in the body, theduration of its presence as well as its other qualities. Button batteries are particularlydangerous and require prompt identification and rapid removal. Their contents are stronglyalkaline and corrosion will lead to chemical burns and disruption of the organ concerned, i.e.in the oeophagus. An electrically active battery will allow a current to be generated withresulting tissue trauma in its vicinity.A large blunt object can cause pressure necrosis or oedema. On the other hand, a sharpbody will tend to migrate by penetrating deeper. This can result in haemorrhage or abscessformation.Clinical Symptoms and SignsThe symptoms and signs of foreign bodies are greatly influenced by their position inthe upper aerodigestive tract and ear. Table 5.1.1. illustrates the clinical findings in thevarious regions. Penetration of the middle and inner ear may cause vertigo, sensori-neuralhearing loss and facial palsy. A clear otorrhoea could be due to cerebrospinal fluid orperilymph leakage.Pain at the angle of the mandibula is indicative of involvement of the tonsillar fossa;a foreign body at the tongue base will give rise to pain under the chin. Retrosternal,suprasternal or back pain may arise from a foreign body in the oesophagus.Diagnosis and Special InvestigationsThe diagnosis depends on an accurate history which is usually forthcoming andobvious. It does happen, however, that no relevant history is obtained or that a long time haselapsed since the initial incident and before the onset of the first symptoms.An adequate and thorough examination is imperative and this should be done by atrained otolaryngologist and an experienced endoscopist. Local or general anaesthesia may berequired. X-ray examination is usually very valuable and should always be used wherefeasible. Many foreign bodies are unfortunately radiolucent but other tell-tale findings maystill help in the definitive diagnosis. A lateral X-ray of the upper aerodigestive tract is most2